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Posting Date: 01/27/2022
General E/M Information
General E/M Information Please explain the terms “auxiliary personnel” and “clinical staff” in the context of Medicare services. Answer: These terms are often used in defining which staff members can perform Medicare services [...]
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Posting Date: 04/28/2015
Advance Beneficiary Notice of Noncoverage
Section 4: Getting Ready to Bill Medicare Advance Beneficiary Notice of Noncoverage An ABN is a written notice a provider gives to a Medicare beneficiary before items or services are furnished, when the provider believes that Medicare [...]
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Posting Date: 04/28/2015
Common Working File
Section 4: Getting Ready to Bill Medicare Common Working File The CWF was developed in 1989 as a means to maintain all of the records for each Medicare beneficiary. These records are a detailed account of each Medicare beneficiary’s status [...]
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Posting Date: 04/28/2015
Fiscal Intermediary Standard System
Section 4: Getting Ready to Bill Medicare Fiscal Intermediary Standard System National Government Services utilizes FISS to process claims and maintain Medicare beneficiary information. Providers have access to this information through a [...]
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Posting Date: 01/18/2022
Appeals Process
Section 3: Fraud and Abuse Appeals Process Table of Contents Appeals Process The Five Levels of Appeal Appeals Request Process First Level—Redetermination Second Level—Reconsideration Third Level—Administrative Law Judge [...]
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Posting Date: 04/28/2015
Comprehensive Error Rate Testing Process
Section 3: Fraud and Abuse Comprehensive Error Rate Testing Process Table of Contents Comprehensive Error Rate Testing Process What is CERT? Who Performs CERT? How Does It Work? CERT Information Available from CMS [Return to Top] [...]
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Posting Date: 04/28/2015
Registration of the Medicare Patient
Section 4: Getting Ready to Bill Medicare Registration of the Medicare Patient When a Medicare beneficiary receives hospital or other medical services, he/she is generally registered at the facility. It is possible that the patient may [...]
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Posting Date: 11/18/2020
Fraud and Abuse/Compliance Resources
Section 3: Fraud and Abuse Fraud and Abuse/Compliance Resources CMS Resources CMS IOM Publication 100-08, Program Integrity Manual OIG website OIG Fraud Prevention and Detection NGS Fraud and Abuse Resources Reviewed 6/4/2024
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Posting Date: 04/28/2015
Office of Inspector General
Section 3: Fraud and Abuse Office of Inspector General Table of Contents Office of Inspector General Compliance Programs Benefits of a Compliance Program Elements of A Compliance Program OIG Compliance Guidance Self-Discovery [...]
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Posting Date: 01/19/2021
Coordination of Benefits Trading Partners
Section 2: Medicare Basics Coordination of Benefits Trading Partners COBC exclusively crosses over all claims to trading partners. “Trading partner” is defined as an issuer of an insurance policy that supplements Medicare or a state agency [...]
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Posting Date: 04/27/2015
Fundamentals of Medicare: Program Safeguard Contractor/Zone Program Integrity Contractor
Section 3: Fraud and Abuse Program Safeguard Contractor/Zone Program Integrity Contractor The primary goal of the PSC/ZPIC is to: identify cases of suspected fraud; develop them thoroughly and in a timely manner; and take immediate [...]
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Posting Date: 02/27/2014
Benefit Integrity
Section 3: Fraud and Abuse Benefit Integrity Providers have an obligation, under law, to conform to the requirements of Medicare. A key to avoiding fraud and abuse is the integrity of the provider as an entity and of each individual that is [...]
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Posting Date: 04/27/2015
Fraud and Abuse
Section 3: Fraud and Abuse Fraud and Abuse Table of Contents Fraud and Abuse Examples of Fraud Examples of Abuse [Return to Top] Fraud and Abuse Fraud occurs when there is an intentional deception or misrepresentation that an [...]
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Posting Date: 01/19/2021
Medicare Secondary Payer
Section 2: Medicare Basics Medicare Secondary Payer Table of Contents Medicare Secondary Payer MSP Provisions MSP Billing - General Benefits Coordination & Recovery Center Contacting the BCRC [Return to Top] Medicare [...]
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Posting Date: 01/19/2021
Medicare Advantage Organizations
Section 2: Medicare Basics Medicare Advantage Organizations Table of Contents What are Medicare Health Plans? Medicare Managed Care Plans [Return to Top] What are Medicare Health Plans? Medicare health plans provide different ways [...]
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Posting Date: 04/24/2015
Medicare Eligibility and Premiums
Section 2: Medicare Basics Medicare Eligibility and Premiums The following groups of people are eligible for Medicare: Individuals aged 65 or older (or their spouse) who have worked at least 40 quarters, or ten years, in Medicare-covered [...]
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Posting Date: 04/24/2015
What Is the Medicare Program and How Is It Funded?
Section 2: Medicare Basics What Is the Medicare Program and How Is it Funded? Medicare is a federally funded health insurance program for: People age 65 or older Certain individuals under age 65 who qualify due to disability People with [...]
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Posting Date: 04/24/2015
The History of Medicare
Section 2: Medicare Basics The History of Medicare During the 30 years following the passage of the SSA in 1935, many attempts were made to include health insurance as part of the Social Security system. It was not until the bill H.R. 6675 [...]
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Posting Date: 04/24/2015
Fundamentals of Medicare: Information References
Section 1: Introduction Information References Table of Contents Information References Telephone Inquiries Interactive Voice Response Eligibility Information Claim Status Information Check and Remittance Information General [...]
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Posting Date: 04/24/2015
Fundamentals of Medicare: Glossary of Terms
Section 1: Introduction Glossary of Terms Beneficiary: An individual who is eligible for Medicare. Benefit Period: The way that Medicare measures the use of hospital and SNF inpatient days. Claim: A bill for services rendered by a provider [...]
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Posting Date: 05/31/2024
Medicare Administrative Contractors
Section 1: Introduction Medicare Administrative Contractors What's A MAC Who are the MACs Table of Contents Medicare Administrative Contractors Who Is National Government Services? The Focus of the Provider Outreach & Education [...]
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Posting Date: 11/03/2020
Legacy Provider Numbers/Provider Transaction Access Numbers (PTANs)
Section 1: Introduction Legacy Provider Numbers/Provider Transaction Access Numbers Table of Contents Legacy Provider Numbers/Provider Transaction Access Numbers State Code Facility Type Third-Digit Specialty Unit Designations [...]
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Posting Date: 02/14/2014
National Provider Identifier
Section 1: Introduction National Provider Identifier The NPI is a HIPAA Administrative Simplification standard. The NPI is a unique identification number for covered health care providers that have replaced the legacy provider number. [...]
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Posting Date: 04/24/2015
Privacy Act
Section 1: Introduction Privacy Act The purpose of the Privacy Act of 1974 (Act), Title 5, United States Code, Section 552a, is to balance the government’s need to maintain information about individuals with the rights of individuals to be [...]
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Posting Date: 04/28/2015
Disclosure of Health Insurance Information
Section 1: Introduction Disclosure of Health Insurance Information Providers have restrictions on the information that they may disclose. The CMS IOM, Publication 100, Medicare General Information, Eligibility and Entitlement Manual, Chapter [...]
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Posting Date: 11/03/2020
Voluntary and Involuntary Termination of Provider Agreement
Section 1: Introduction Voluntary and Involuntary Termination of Provider Agreement Table of Contents Voluntary and Involuntary Termination of Provider Agreement Voluntary (Provider-Requested) Termination of Agreement Involuntary [...]
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Posting Date: 04/13/2023
Top Tobacco Counseling Claim Errors
Top Tobacco Counseling Claim Errors Reason Code(s) Description Avoiding/Correcting This Error OA-18 A duplicate claim submission occurs when a provider resubmits a claim either on paper or electronically for a [...]
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Posting Date: 04/04/2024
New Provider Center
New Provider Center National Government Services: A Medicare Administrative Contractor – Who Are We? A MAC is a private health care insurer to whom the CMS has awarded geographic jurisdiction to process FFS Medicare claims for beneficiaries [...]
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Posting Date: 04/27/2022
New Provider Center
New Provider Center National Government Services: A Medicare Administrative Contractor – Who Are We? A MAC is a private health care insurer to whom the CMS has awarded geographic jurisdiction to process FFS Medicare claims for beneficiaries [...]
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Posting Date: 04/04/2024
New Provider Center
New Provider Center National Government Services: A Medicare Administrative Contractor – Who Are We? A MAC is a private health care insurer to whom the CMS has awarded geographic jurisdiction to process FFS Medicare claims for beneficiaries [...]
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Posting Date: 09/01/2021
New Provider Center
New Provider Center National Government Services: A Medicare Administrative Contractor Who Are We? A MAC is a private health care insurer to whom the CMS has awarded geographic jurisdiction to process FFS Medicare claims for beneficiaries [...]
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Posting Date: 11/08/2024
Track the Status of Your Application
How to Search You may track the status of your provider enrollment application (PECOS or paper) submissions via the: Check Provider Enrollment Application Status tool by: Case number/web tracker id or NPI and TIN combination [...]
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Posting Date: 11/08/2024
Provider Enrollment Application Process Timeline
All MACs, including National Governments Services, have a goal to finalize an Internet-based PECOS application within 15 days and a CMS-855 paper application within 30 days, if all required information is available. About the Application [...]
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Posting Date: 11/08/2024
Provider Enrollment: Completing the CMS-855A Paper Application
During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.
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Posting Date: 11/08/2024
Provider Enrollment Revalidation Overview
During this webinar, learn about important changes in the revalidation process, how to determine Medicare enrollment revalidation due date and information to avoid disruption in Medicare billing.
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Posting Date: 11/08/2024
Getting Access to PECOS
During this webinar, we’ll discuss how to obtain access to the Internet-based Provider Enrollment Chain & Ownership System (PECOS) and gain connection to provider enrollment record as well as understand other Centers for Mediacre & Medicaid [...]
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Posting Date: 01/05/2024
Intensive Outpatient Program
Intensive Outpatient Program Table of Contents IOP vs. Partial Hospitalization Program Provider Types Eligible to Provide IOP Medicare Beneficiary Eligible for IOP Services Active Treatment and Treatment Plan Covered IOP Services [...]
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